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Bouloux GF, Chou J, DiFabio V, Ness G, Perez D, Mercuri L, Chung W, Klasser GD, Bender SD, Kraus S, Crago CA. Guidelines for the Management of Patients With Orofacial Pain and Temporomandibular Disorders. J Oral Maxillofac Surg 2024:S0278-2391(24)00200-3. [PMID: 38643965 DOI: 10.1016/j.joms.2024.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2024] [Accepted: 03/19/2024] [Indexed: 04/23/2024]
Affiliation(s)
- Gary F Bouloux
- Family Professor, Division Chief, Oral and Maxillofacial Surgery, Emory University School of Medicine, Atlanta, GA.
| | - Joli Chou
- Associate Professor, Department Of Oral and Maxillofacial Surgery, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
| | - Vince DiFabio
- Associate Clinical Professor, Oral and Maxillofacial Surgery, University of Maryland School of Dentistry, University of Maryland Medical Center, Baltimore, MD
| | - Greg Ness
- Emeritus Professor-Clinical, The Ohio State University, Private Practice, Oral and Facial Surgery for Adults and Children, Columbus, OH
| | - Daniel Perez
- Associate Professor and Program Director, Oral and Maxillofacial Surgery, University Texas Health Sciences San Antonio, San Antonio, TX
| | - Louis Mercuri
- Visiting Professor, Department of Orthopedic Surgery, Rush University Medical Center, Adjunct Professor, Department of Bioengineering, University of Illinois Chicago, Chicago, IL
| | - William Chung
- Clinical Professor, Residency Program Director, Indiana University School of Dentistry and Hospital Medicine, Indianapolis, IN
| | - Gary D Klasser
- Certificate Orofacial Pain, Professor, Louisiana State University Health Sciences Center, School of Dentistry, New Orleans, LA
| | - Steven D Bender
- Clinical Associate Professor, Director, Clinical Center for Facial Pain and Sleep Medicine, Department of Oral and Maxillofacial Surgery, Texas A&M School of Dentistry, Dallas, TX
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Temporomandibular Joint Surgery. J Oral Maxillofac Surg 2023; 81:E195-E220. [PMID: 37833023 DOI: 10.1016/j.joms.2023.06.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2023]
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Hajibandeh J, Peacock ZS. Pediatric Mandible Fractures. Oral Maxillofac Surg Clin North Am 2023; 35:555-562. [PMID: 37517978 DOI: 10.1016/j.coms.2023.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/01/2023]
Abstract
The management of pediatric facial fractures requires several considerations by the treating surgeon. Pediatric facial fractures occur less commonly than in adults. Among fracture patterns in children, studies have repeatedly demonstrated that mandible fractures are the most common facial fracture particularly the condyle. Most fractures in children are amenable to nonsurgical or closed treatment; however, certain indications exist for open treatment. The literature describing epidemiology, treatment trends, and long-term outcomes are limited in comparison with adult populations. The purpose of the article is to review the etiology, workup, and management of mandible fractures in children.
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Affiliation(s)
- Jeffrey Hajibandeh
- Massachusetts General Hospital, Division of Oral & Maxillofacial Surgery, Warren 1201, 55 Fruit Street, Boston, MA 02127, USA.
| | - Zachary S Peacock
- Massachusetts General Hospital, Division of Oral & Maxillofacial Surgery, Warren 1201, 55 Fruit Street, Boston, MA 02127, USA
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Nourwali I, Aljohani M. Conservative management and follow-up of bilateral condylar fractures in pediatric patients: A case report. Clin Case Rep 2023; 11:e7842. [PMID: 37636881 PMCID: PMC10457479 DOI: 10.1002/ccr3.7842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 08/05/2023] [Accepted: 08/14/2023] [Indexed: 08/29/2023] Open
Abstract
Key Clinical Message Conservative treatment of bilateral condylar fractures, including intermaxillary fixation using arch bars and elastic bands, yields satisfactory results in pediatric patients. Therefore, the conservative approach should be considered the first line of treatment for bilateral condylar mandibular fractures in pediatric patients. Abstract Road traffic accidents (RTAs) are considered the leading cause of mortality and morbidity of children and adults in Saudi Arabia. Head injuries and fractures are the most common form of injuries resulting from RTAs, with mandibular fractures being the most common head injury; condylar fractures are the most frequent type of mandibular fracture. A review of the literature reveals diverse opinions about the best approach for treating bilateral condylar fractures in pediatric patients. The findings of the literature review are reported in this study. The case presented here shows the result of adopting a conservative approach to treating a bilateral extracapsular displaced condylar fracture. An elastic band was fixed onto intermaxillary fixation (IMF) screws at the midline upper and lower jaws; the patient was followed up for almost 3 years. The conservative approach yielded excellent results, as both condyles were fully repositioned and healed, without causing any deviation or limitation of the mouth opening. The results of this case support considering the conservative approach as the first line of treatment for bilateral condylar mandibular fractures in pediatric patients.
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Affiliation(s)
- Ibrahim Nourwali
- Department of Oral and Maxillofacial Surgery, College of DentistryTaibah UniversityMadinahSaudi Arabia
| | - Marwan Aljohani
- Department of Oral and Maxillofacial Surgery, College of DentistryTaibah UniversityMadinahSaudi Arabia
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Morrison KA, Flores RL. A novel treatment of pediatric bilateral condylar fractures with lateral dislocation of the temporomandibular joint (TMJ) using transfacial pinning. Case Reports Plast Surg Hand Surg 2023; 10:2242498. [PMID: 37547270 PMCID: PMC10402857 DOI: 10.1080/23320885.2023.2242498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 07/25/2023] [Indexed: 08/08/2023]
Abstract
A 3-year-old patient sustained a tripartite mandibular fracture, including bilateral condylar fractures with lateral dislocation of the left condyle and symphyseal fracture. Staged lower jaw reconstruction with closed reduction of the laterally dislocated condyle, transfacial pinning between the mandibular angles, MMF using circummandibular wiring and intermaxillary fixation screws was performed.
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Affiliation(s)
- Kerry A. Morrison
- Hansjörg Wyss Department of Plastic Surgery, NY University Langone Health, New York, NY, USA
| | - Roberto L. Flores
- Hansjörg Wyss Department of Plastic Surgery, NY University Langone Health, New York, NY, USA
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Jenkyn I, Bosley R, Jenkyn C, Basyuni S, Fowell C. Management of Mandibular Condyle Fractures in Paediatric Patients: a Systematic Review. J Oral Maxillofac Res 2023; 14:e2. [PMID: 37521323 PMCID: PMC10382193 DOI: 10.5037/jomr.2023.14202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 06/30/2023] [Indexed: 08/01/2023]
Abstract
Objectives This systematic review searched three of the most used databases to assess if current evidence suggested a difference between surgical and non-surgical management of mandibular condyle fractures in paediatric patients. Material and Methods An electronic literature search was conducted of three well known databases - Ovid, PubMed and Web of Science. Studies included were conducted paediatric patients, in humans, written in English and published from January 1st 1996 until April 1st 2022. Data collection was carried out by two independent reviewers. Data collated from studies without high risk of bias was pooled for surgical vs non-surgical management and total tallies of all outcomes presented. Presence or absence of complications was recorded in 4 x 4 tables for each outcome and compared using a Chi-Square test. Results After duplicate records were removed, 182 records were screened. After exclusion of unsuitable reports, 20 were included in the review. Further analysis showed the included studies had high risk of bias. Given this, comparison of this pooled data showed no significant difference between management methods. Conclusions Presently it appears conservative management is functionally adequate without risks associated with surgical management, even though incidence of these risks was shown to be low in the studies included in this review.
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Affiliation(s)
- Ian Jenkyn
- Oral and Maxillofacial Surgery Department, Addenbrookes Hospital, Cambridge, Hills Rd, Cambridge CB2 0QQUnited Kingdom.
| | - Robert Bosley
- The University of Cambridge School of Clinical Medicine, Addenbrooke's Hospital, Hills Rd, Cambridge CB2 0SPUnited Kingdom.
| | - Claire Jenkyn
- Barts and The London School of Medicine and Dentistry, Garrod Building, Turner St, London E1 2ADUnited Kingdom.
| | - Shadi Basyuni
- Oral and Maxillofacial Surgery Department, Addenbrookes Hospital, Cambridge, Hills Rd, Cambridge CB2 0QQUnited Kingdom.
| | - Christopher Fowell
- Oral and Maxillofacial Surgery Department, Addenbrookes Hospital, Cambridge, Hills Rd, Cambridge CB2 0QQUnited Kingdom.
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Khattak YR, Sardar T, Iqbal A, Khan MH, Khan A, Ullah U, Ahmad I. Treatment of pediatric bilateral condylar fractures: A comprehensive analysis. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2023; 124:101339. [PMID: 36403929 DOI: 10.1016/j.jormas.2022.11.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 11/14/2022] [Accepted: 11/15/2022] [Indexed: 11/18/2022]
Abstract
Pediatric bilateral condylar fractures (PBCF) is a rare clinical pathology, where the management is carried out with both conservative and surgical approaches. The purpose of this study was to analyze and compare these two treatment approaches and their associated long term complications in PBCF. An extensive literature review- through the search of online databases- was conducted to survey, collect, analyze and compare the reported outcomes of different treatment modalities for PBCF. The number of studies presenting PBCF case reports was 16, while the number of such retrospective studies included here was 19. Analyses of these studies revealed that the conservative treatment is preferred in PBCF patients younger than 12 years of age. Moreover, a composite approach where the open reduction and internal fixation (ORIF) is carried out for one side while the intermaxillary fixation (IMF) for the contralateral side is frequently reported for the management of PBCF cases; this approach appears effective in improving daily functioning of temporomandibular joint and reducing long term complications. Performing ORIF for one side while IMF for the contralateral side seems the most common treatment approach in PBCF. This study may help in rapid decision making for treatment selection of PBCF patients while minimizing the risk for late complications.
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Affiliation(s)
| | - Tariq Sardar
- Oral and Maxillofacial Surgery, KMU-Institute of Dental Sciences, Kohat, Pakistan.
| | | | | | - Ajmal Khan
- Oral and Maxillofacial Surgery, Saidu Medical College, Swat, Pakistan
| | - Umer Ullah
- Oral and Maxillofacial Surgery, Rehman College of Dentistry, Peshawar, Pakistan
| | - Iftikhar Ahmad
- Institute of Radiotherapy and Nuclear Medicine (IRNUM), Peshawar, Pakistan
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Sabbagh H, Nikolova T, Kakoschke SC, Wichelhaus A, Kakoschke TK. Functional Orthodontic Treatment of Mandibular Condyle Fractures in Children and Adolescent Patients: An MRI Follow-Up. LIFE (BASEL, SWITZERLAND) 2022; 12:life12101596. [PMID: 36295031 PMCID: PMC9605380 DOI: 10.3390/life12101596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 10/06/2022] [Accepted: 10/11/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND The purpose of this study was to retrospectively evaluate and follow up a conservative treatment approach with functional orthodontic appliances for the management of mandibular condyle fractures in children and adolescent patients. METHODS Between 2020 and 2022, the treatment records of patients with mandibular condyle fractures receiving a functional orthodontic treatment (FOT) were evaluated. In addition to the clinical and functional findings, magnetic resonance images of the mandibular condyles and surrounding structures were assessed. RESULTS Out of 61 patients, 8 met the inclusion criteria. The follow-up examination records showed no functional limitations. In 75% of cases, mild midline deviations persisted (mean 1.1 mm) without significant alterations to the occlusal relationships. Magnetic resonance imaging (MRI) showed the remodeling of the condyles and the restitution of the ramus heights, even in dislocated and displaced fractures. In three cases, a partial displacement of the articular disc was observed at the follow-up. No differences in the remodeling patterns were noted depending on age, sex, or fracture location. CONCLUSIONS A FOT led to favorable functional and morphologic outcomes, supporting the concept of a conservative functional approach in children and adolescent patients. Functional adjunctive therapy should be considered in the conservative treatment of mandibular condyle fractures in growing patients.
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Affiliation(s)
- Hisham Sabbagh
- Department of Orthodontics and Dentofacial Orthopedics, University Hospital, LMU Munich, Goethestrasse 70, 80336 Munich, Germany
- Correspondence: ; Tel.: +49-89-4400-53223
| | - Trayana Nikolova
- Department of Radiology, University Hospital, LMU Munich, Marchioninistrasse 15, 81337 Munich, Germany
| | - Sara Carina Kakoschke
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, University Hospital, LMU Munich, Lindwurmstrasse 2a, 80337 Munich, Germany
- Department of General, Visceral, and Transplant Surgery, University Hospital, LMU Munich, Marchioninistrasse 15, 81337 Munich, Germany
| | - Andrea Wichelhaus
- Department of Orthodontics and Dentofacial Orthopedics, University Hospital, LMU Munich, Goethestrasse 70, 80336 Munich, Germany
| | - Tamara Katharina Kakoschke
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, University Hospital, LMU Munich, Lindwurmstrasse 2a, 80337 Munich, Germany
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Rikhotso RE, Reyneke JP, Nel M. Does Open Reduction and Internal Fixation Yield Better Outcomes Over Closed Treatment of Mandibular Condylar Fractures? J Oral Maxillofac Surg 2022; 80:1641-1654. [DOI: 10.1016/j.joms.2022.06.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 06/22/2022] [Accepted: 06/22/2022] [Indexed: 11/16/2022]
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Jiao MN, Zhang TM, Yang K, Xu ZY, Zhang GM, Tian YY, Liu H, Yan YB. Absorbance or organization into ankylosis: a microarray analysis of haemarthrosis in a sheep model of temporomandibular joint trauma. BMC Oral Health 2021; 21:668. [PMID: 34961493 PMCID: PMC8713393 DOI: 10.1186/s12903-021-02033-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 12/22/2021] [Indexed: 11/29/2022] Open
Abstract
Background Traumatic haemarthrosis was hypothesized to be the etiology of temporomandibular (TMJ) ankylosis. Here, taking haematoma absorbance as a control, we aimed to reveal the molecular mechanisms involved in haematoma organizing into ankylosis using transcriptome microarray profiles. Material/methods Disk removal was performed to building haematoma absorbance (HA) in one side of TMJ, while removal of disk and articular fibrous layers was performed to induced TMJ ankylosis through haematoma organization (HO) in the contralateral side in a sheep model. Haematoma tissues harvested at days 1, 4 and 7 postoperatively were examined by histology, and analyzed by Affymetrix OviGene-1_0-ST microarrays. The DAVID were recruited to perform the Gene Ontology and Kyoto Encyclopedia of Genes and Genomes pathway analysis for the different expression genes (DEGs). The DEGs were also typed into protein–protein interaction (PPI) networks to get the interaction data. Six significant genes screened from PPI analysis, were confirmed by real-time PCR. Results We found 268, 223 and 17 DEGs at least twofold at days 1, 4 and 7, respectively. At day 1, genes promoting collagen ossification (POSTN, BGN, LUM, SPARC), cell proliferation (TGF-β), and osteogenic differentiation of mesenchymal stem cells (BMP-2) were up-regulated in the HO side. At day 4, several genes involved in angiogenesis (KDR, FIT1, TEK) shower higher expression in the HO side. While HA was characterized by a continuous immune and inflammatory reaction. Conclusions Our results provide a comprehensive understanding of the role of haematoma in the onset and progress of TMJ ankylosis. The study will contribute to explaining why few injured TMJs ankylose and most do not from the molecular level. Supplementary Information The online version contains supplementary material available at 10.1186/s12903-021-02033-w.
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Affiliation(s)
- Mai-Ning Jiao
- Tianjin Medical University, 22 Qi-xiang-tai Road, Heping District, Tianjin, 300070, People's Republic of China.,Department of Oromaxillofacial-Head and Neck Surgery, Tianjin Stomatological Hospital, 75 Dagu Road, Heping District, Tianjin, 300041, People's Republic of China.,Tianjin Key Laboratory of Oral and Maxillofacial Function Reconstruction, 75 Dagu Road, Heping District, Tianjin, 300041, People's Republic of China
| | - Tong-Mei Zhang
- Tianjin Medical University, 22 Qi-xiang-tai Road, Heping District, Tianjin, 300070, People's Republic of China.,Department of Oromaxillofacial-Head and Neck Surgery, Tianjin Stomatological Hospital, 75 Dagu Road, Heping District, Tianjin, 300041, People's Republic of China.,Tianjin Key Laboratory of Oral and Maxillofacial Function Reconstruction, 75 Dagu Road, Heping District, Tianjin, 300041, People's Republic of China
| | - Kun Yang
- Department of Oral and Maxillofacial Surgery, China Three Gorges University Affiliated Renhe Hospital, 410 Yiling Ave, Hubei, 443001, People's Republic of China
| | - Zhao-Yuan Xu
- Department of Oromaxillofacial-Head and Neck Surgery, Tianjin Stomatological Hospital, 75 Dagu Road, Heping District, Tianjin, 300041, People's Republic of China.,Tianjin Key Laboratory of Oral and Maxillofacial Function Reconstruction, 75 Dagu Road, Heping District, Tianjin, 300041, People's Republic of China
| | - Guan-Meng Zhang
- Department of Oromaxillofacial-Head and Neck Surgery, Tianjin Stomatological Hospital, 75 Dagu Road, Heping District, Tianjin, 300041, People's Republic of China.,Tianjin Key Laboratory of Oral and Maxillofacial Function Reconstruction, 75 Dagu Road, Heping District, Tianjin, 300041, People's Republic of China
| | - Yuan-Yuan Tian
- Department of Oromaxillofacial-Head and Neck Surgery, Tianjin Stomatological Hospital, 75 Dagu Road, Heping District, Tianjin, 300041, People's Republic of China.,Tianjin Key Laboratory of Oral and Maxillofacial Function Reconstruction, 75 Dagu Road, Heping District, Tianjin, 300041, People's Republic of China
| | - Hao Liu
- Department of Oromaxillofacial-Head and Neck Surgery, Tianjin Stomatological Hospital, 75 Dagu Road, Heping District, Tianjin, 300041, People's Republic of China. .,Tianjin Key Laboratory of Oral and Maxillofacial Function Reconstruction, 75 Dagu Road, Heping District, Tianjin, 300041, People's Republic of China.
| | - Ying-Bin Yan
- Department of Oromaxillofacial-Head and Neck Surgery, Tianjin Stomatological Hospital, 75 Dagu Road, Heping District, Tianjin, 300041, People's Republic of China. .,Tianjin Key Laboratory of Oral and Maxillofacial Function Reconstruction, 75 Dagu Road, Heping District, Tianjin, 300041, People's Republic of China.
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Semi-Rigid Fixation Using a Sliding Plate for Treating Fractures of the Mandibular Condylar Process. J Clin Med 2021; 10:jcm10245782. [PMID: 34945078 PMCID: PMC8705034 DOI: 10.3390/jcm10245782] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 12/09/2021] [Accepted: 12/09/2021] [Indexed: 11/18/2022] Open
Abstract
Occlusal displacement often occurs after surgery for condylar process fractures because it is difficult to reduce these fractures precisely. However, performing semi-rigid fixation using a sliding plate may overcome this limitation. A retrospective clinical comparison between semi-rigid and rigid fixations was performed. Among 34 patients who had unilateral condylar process fractures, 17 were treated with rigid fixation and the remaining with semi-rigid fixation using a sliding plate. For all patients, panoramic radiographs were collected 1 day and 6 months after surgery. In these radiographs, ramus height and condylar process inclination were measured, and the differences between the fractured and normal sides were assessed. Additionally, the radiographic density of the fracture area was measured. Differences in surgical outcomes and operative times between the two groups and changes in postoperative deviations within each group were analyzed. There was no statistically significant difference in ramus height and condylar process inclination between the two groups at postoperative day 1 and 6 months. Radio-density was observed to be higher in the rigid fixation group, and it increased with time in both groups. The semi-rigid fixation group had a significantly shorter operative time than the other group did. Semi-rigid and rigid fixations showed no differences in terms of effectiveness and outcomes of surgery. In terms of operative time, semi-rigid fixation was superior to rigid fixation.
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Stähli C, Eliades T, Papageorgiou SN. Functional appliance treatment for mandibular fractures: A systematic review with meta-analyses. J Oral Rehabil 2021; 48:945-954. [PMID: 33963591 PMCID: PMC8362118 DOI: 10.1111/joor.13178] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 04/12/2021] [Accepted: 05/03/2021] [Indexed: 12/31/2022]
Abstract
OBJECTIVES Mandibular collum fractures among growing patients can lead to abnormal growth, function, esthetics and ultimately quality of life. Among the proposed treatment alternatives, orthopaedic treatment with functional appliances has been suggested, with encouraging results. Aim of the present systematic review was to critically appraise existing evidence on the outcome of functional appliance treatment among growing patients with mandibular collum fractures. MATERIALS AND METHODS Eight databases were searched up to October 2020 for randomised and non-randomised clinical studies assessing functional appliance treatment outcome for children with mandibular fractures. After duplicate study selection, data extraction and risk of bias assessment, random effects meta-analyses of mean differences (MD) and their 95% confidence intervals (CIs) were performed, followed by assessment of the quality of evidence with GRADE. RESULTS A total of 8 unique studies (one prospective and nine retrospective non-randomised) with 223 children could be identified. Functional appliance treatment was associated with greater anteroposterior condyle dimensions of the injured condyle compared with the contralateral healthy condyle (3 studies; MD = 0.87 mm; 95% CI = 0.30 to 1.45 mm; p = .003). No difference was found in the mesiodistal condyle size between the injured and the contralateral healthy joint (3 studies; MD = -0.05 mm; 95% CI = -1.05 to 0.95 mm; p = .92), but collum length was smaller at the injured side compared with the contralateral one (1 study; MD = -2.89 mm; 95% CI = -5.29 to -0.49 mm; p = .02). Treatment outcome might be influenced by patient age, patient sex and severity/localisation of the fracture, but the quality of evidence for all analyses was very low due to methodological limitations leading to bias. CONCLUSIONS While some evidence exists that functional appliances might lead to good clinical rehabilitation of fractured mandibular condyles, including considerable bone remodelling, available studies are small and have methodological weaknesses.
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Affiliation(s)
- Corinne Stähli
- Clinic of Orthodontics and Pediatric DentistryCenter of Dental MedicineUniversity of ZurichZurichSwitzerland
| | - Theodore Eliades
- Clinic of Orthodontics and Pediatric DentistryCenter of Dental MedicineUniversity of ZurichZurichSwitzerland
| | - Spyridon N. Papageorgiou
- Clinic of Orthodontics and Pediatric DentistryCenter of Dental MedicineUniversity of ZurichZurichSwitzerland
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Lopez J, Lake IV, Khavanin N, Kachniarz B, Najjar O, Pourtaheri N, Redett RJ, Manson PN, Dorafshar AH. Noninvasive Management of Pediatric Isolated, Condylar Fractures: Less Is More? Plast Reconstr Surg 2021; 147:443-452. [PMID: 33565828 DOI: 10.1097/prs.0000000000007527] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The purpose of this study was to examine injury patterns in pediatric mandibular condylar fractures and to propose and evaluate the validity of an institutional treatment algorithm for such fractures. METHODS A retrospective chart review was conducted on pediatric patients who presented to the authors' institution with isolated mandibular condylar fractures between 1990 and 2016. Patients were categorized by dentition, and information regarding demographics, injury characteristics, management, and complications was compiled. RESULTS Forty-three patients with 50 mandibular condylar fractures were identified. Twelve patients (27.9 percent) had deciduous dentition, 15 (34.9 percent) had mixed dentition, and 16 (37.2 percent) had permanent dentition. The most common fracture pattern in all groups was diacapitular [n = 30 (60 percent)]; however, older groups showed higher rates of condylar base fractures and bilateral fractures (p = 0.029 and p = 0.011, respectively). Thirty-one patients (72.1 percent) were treated with nonoperative management, 10 (23.2 percent) with closed treatment and mandibulomaxillary fixation, and two (4.7 percent) with open treatment and mandibulomaxillary fixation; nonoperative treatment was more common in younger patients (p = 0.008). Management for 10 patients (23.2 percent) was nonadherent to the treatment algorithm. Eight patients had complications (18.6 percent). Common complications included temporomandibular joint ankylosis (n = 2) and malocclusion (n = 2). Although complications were seen in all groups, adherence to the algorithm was associated with an 81.8 percent reduction in odds of complications (p = 0.032). CONCLUSIONS Nonoperative management has a low complication rate in deciduous children. Children with permanent/mixed dentition may undergo closed treatment and mandibulomaxillary fixation if they have malocclusion/contralateral open bite, significant condylar dislocation, and ramus height loss greater than 2 mm. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, III.
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Affiliation(s)
- Joseph Lopez
- From the Department of Plastic and Reconstructive Surgery, The Johns Hopkins University School of Medicine; the Division of Plastic and Reconstructive Surgery, Department of Surgery, Yale School of Medicine; and Rush Medical College of Rush University
| | - Isabel V Lake
- From the Department of Plastic and Reconstructive Surgery, The Johns Hopkins University School of Medicine; the Division of Plastic and Reconstructive Surgery, Department of Surgery, Yale School of Medicine; and Rush Medical College of Rush University
| | - Nima Khavanin
- From the Department of Plastic and Reconstructive Surgery, The Johns Hopkins University School of Medicine; the Division of Plastic and Reconstructive Surgery, Department of Surgery, Yale School of Medicine; and Rush Medical College of Rush University
| | - Bartlomiej Kachniarz
- From the Department of Plastic and Reconstructive Surgery, The Johns Hopkins University School of Medicine; the Division of Plastic and Reconstructive Surgery, Department of Surgery, Yale School of Medicine; and Rush Medical College of Rush University
| | - Omar Najjar
- From the Department of Plastic and Reconstructive Surgery, The Johns Hopkins University School of Medicine; the Division of Plastic and Reconstructive Surgery, Department of Surgery, Yale School of Medicine; and Rush Medical College of Rush University
| | - Navid Pourtaheri
- From the Department of Plastic and Reconstructive Surgery, The Johns Hopkins University School of Medicine; the Division of Plastic and Reconstructive Surgery, Department of Surgery, Yale School of Medicine; and Rush Medical College of Rush University
| | - Richard J Redett
- From the Department of Plastic and Reconstructive Surgery, The Johns Hopkins University School of Medicine; the Division of Plastic and Reconstructive Surgery, Department of Surgery, Yale School of Medicine; and Rush Medical College of Rush University
| | - Paul N Manson
- From the Department of Plastic and Reconstructive Surgery, The Johns Hopkins University School of Medicine; the Division of Plastic and Reconstructive Surgery, Department of Surgery, Yale School of Medicine; and Rush Medical College of Rush University
| | - Amir H Dorafshar
- From the Department of Plastic and Reconstructive Surgery, The Johns Hopkins University School of Medicine; the Division of Plastic and Reconstructive Surgery, Department of Surgery, Yale School of Medicine; and Rush Medical College of Rush University
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Outcomes of functional treatment of condylar mandibular fractures with an articular impact: a retrospective study of 108 children. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2021; 123:177-183. [PMID: 34224922 DOI: 10.1016/j.jormas.2021.06.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 06/29/2021] [Indexed: 11/22/2022]
Abstract
INTRODUCTION The treatment of fractures of the mandibular condylar process remains controversial, especially in children. The aim of this study was to assess the long-term clinical and radiographic outcomes of functional treatments for mandibular condylar fractures with an articular impact. MATERIALS AND METHODS Young patients (< 15 years of age) presenting with either a unilateral or a bilateral mandibular fracture of the condylar process were included in this retrospective study. The clinical analysis focused on investigation of joint amplitudes at 1, 2, 6, 12, and 24 months after the beginning of the treatment, and at the end of their physical growth for the long-term study. Other clinical parameters included temporomandibular joint (TMJ) disorders and facial asymmetry. Photographs of patients and panoramic X-rays were assessed to identify any growth disorders at the end of the follow-up. RESULTS One hundred and eight patients were included in this study, and 33 patients who were no longer undergoing mandibular growth at the time of the last follow-up were included in the long-term study. The mean age at the time of the trauma was 9.33 years, and the mean follow-up was 82.2 months. A significant improvement was observed in the maximal mouth opening (MMO), diduction, and propulsion in the first months after the trauma, reaching 44.31 mm (p < 0.0001), 10.50 mm (p = 0.0001), and 6.33 mm (p = 0.01), respectively, at 6 months. Three patients experienced a clinical posterior vertical insufficiency, one of which required a surgical procedure, while four patients exhibited a ramus asymmetry of up to 10 mm, albeit with no clinical consequences. One case of TMJ ankylosis was noted. CONCLUSION Our study suggests that functional treatment is appropriate for fractures of the mandibular condyle with an articular impact in children, as it promotes mandibular growth and good functional recovery. Children have to be followed up, however, until completion of growth.
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Management of Medially Displaced Sub-Condylar Mandibular Fractures in Pediatric Population Using Novel Atraumatic Approach. J Craniofac Surg 2021; 32:851-854. [PMID: 32897973 DOI: 10.1097/scs.0000000000006993] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
ABSTRACT The appropriate treatment of pediatric mandibular condyle fractures is subject to much debate and concern among surgeons, with improper treatment potentially resulting in a number of adverse outcomes. Such outcomes include the disruption of mandible growth, decreased posterior facial height, facial asymmetry, and temporomandibular joint ankylosis. Several surgical and nonsurgical approaches to these fractures have been described in the literature; however, each one carries its own risk of various complications. In this study, the authors illustrate a new atraumatic approach for mild to moderately displaced subcondylar fractures, with least possible complications and unexpected outcomes. In this study, 6 patients (2 female and 4 male) with unilateral medially displaced condylar base and neck fractures, angulated between 30 and 45 degrees, were treated using a novel intraoral approach. The follow-up period varied from 12 to 18 months. All patients achieved normal occlusion and had painless functioning of the temporomandibular joint with proper mouth opening (>35 mm) without any recurrence at long term follow up. This minimally invasive approach could eliminate the possibility of major complications and be considered a safe and feasible surgical technique for certain cases of pediatric mandibular condyle fracture.
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Bansal A, Yadav P, Bhutia O, Roychoudhury A, Bhalla AS. Comparison of outcome of open reduction and internal fixation versus closed treatment in pediatric mandible fractures-a retrospective study. J Craniomaxillofac Surg 2021; 49:196-205. [PMID: 33483246 DOI: 10.1016/j.jcms.2020.12.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 11/17/2020] [Accepted: 12/25/2020] [Indexed: 10/22/2022] Open
Abstract
The aim of the study was to compare the outcome and complications of open reduction and internal fixation (ORIF) with closed treatment, as well as to review the literature. This was a retrospective study on pediatric patients with mandible fracture. The primary objective was a comparison of outcomes in terms of bone healing, maximal incisal opening (MIO), and occlusion, and the secondary objective was to review complications. A total of 77 pediatric patients (age <12 years) were managed with closed treatment and 23 with ORIF. In all, 62 patients were found with a single fracture (22 patients with parasymphysis fracture and 21 with condyle fracture, followed by symphysis, angle, and body fracture) and 38 patients with more than one fracture, with symphysis and bilateral condyle fracture being the most common. Bone healing was observed in all the patients. Mean MIO was 26.9 ± 2.8 mm and 29.3 ± 1.7 mm in the closed and ORIF group, respectively, and the difference was statistically nonsignificant (p = 0.5). One patient (1.3%) had deranged occlusion, and mobility was observed in one patient (1.3%) in the closed treatment group. Infection and nerve paresthesia were not seen in any patient at follow-up. Although closed treatment is preferred, as it preserves the soft tissue and periosteum, a displaced mandible fracture especially with co-existing condylar fracture should be treated by ORIF.
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Affiliation(s)
- Adity Bansal
- Department of Oral & Maxillofacial Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Poonam Yadav
- Department of Oral & Maxillofacial Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Ongkila Bhutia
- Department of Oral & Maxillofacial Surgery, All India Institute of Medical Sciences, New Delhi, India.
| | - Ajoy Roychoudhury
- Department of Oral & Maxillofacial Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Ashu Seith Bhalla
- Department of Radiology, All India Institute of Medical Sciences, New Delhi, India
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Dislocated pediatric condyle fractures — should conservative treatment always be the rule? J Craniomaxillofac Surg 2020; 48:933-941. [DOI: 10.1016/j.jcms.2020.08.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 06/10/2020] [Accepted: 08/09/2020] [Indexed: 01/26/2023] Open
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Cooney M, O'Connell JE, Vesey JA, Van Eeden S. Non-surgical management of paediatric and adolescent mandibular condyles: A retrospective review of 49 consecutive cases treated at a tertiary referral centre. J Craniomaxillofac Surg 2020; 48:666-671. [DOI: 10.1016/j.jcms.2020.05.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 03/23/2020] [Accepted: 05/23/2020] [Indexed: 11/28/2022] Open
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Li J, Yang H, Han L. Open versus closed treatment for unilateral mandibular extra-capsular condylar fractures: A meta-analysis. J Craniomaxillofac Surg 2019; 47:1110-1119. [DOI: 10.1016/j.jcms.2019.03.021] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 03/08/2019] [Accepted: 03/18/2019] [Indexed: 11/16/2022] Open
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Silva AM, Tomé T, Cunha C, d'Oliveira Coelho J, Valera AC, Filipe V, Scott GR. Unilateral absence of mandibular condyle in a Bronze Age male skeleton from Portugal. INTERNATIONAL JOURNAL OF PALEOPATHOLOGY 2018; 22:168-172. [PMID: 29858108 DOI: 10.1016/j.ijpp.2018.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 04/19/2018] [Accepted: 04/21/2018] [Indexed: 06/08/2023]
Abstract
In 2009, a pit burial dated to the Bronze Age was excavated in Monte do Gato de Cima 3 (Portugal). The purpose of this paper is to describe the pathological absence of the left mandibular condyle noted in an adult male skeleton and to discuss possible diagnoses, including subcondylar fracture, cystic defect, congenital absence, condylar aplasia and mandibular condylysis. The most likely explanation for the pathological alteration is subcondylar fracture with non-union. Although the occurrence of non-union and slight osteoarthritic alterations in the left glenoid fossa were evident, this mandible was likely functional, as can be inferred from dental wear and muscle attachment sites. This trauma probably occurred before adult age when remodelling capacity is still high. Thus, bones and muscles adequately compensated for the trauma and only minor asymmetry developed. Consequently, this injury seems not to have greatly influenced masticatory functions. This is in accordance with clinical data, which demonstrate that, in growing patients, conservative treatment (non-surgical) results in good remodelling and patient recovery. In addition, in the few paleopathological cases published, the healing capacity of these types of mandibular fractures seems to be good, as can be inferred by evidence from the bone.
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Affiliation(s)
- A M Silva
- Laboratory of Prehistory, CIAS - Research Centre for Anthropology and Health, Department of Life Sciences, University of Coimbra, Coimbra, Portugal; Centre for Functional Ecology (CEF), Department of Life Sciences, University of Coimbra, Coimbra, Portugal; UNIARQ, University of Lisbon, Portugal.
| | - T Tomé
- Laboratory of Prehistory, CIAS - Research Centre for Anthropology and Health, Department of Life Sciences, University of Coimbra, Coimbra, Portugal; Programa de Pós-Graduação em Antropologia, Universidade Federal do Pará, Grupo de Quaternário e Pré-História, Centro de Geociências - UC, Portugal
| | - C Cunha
- Laboratory of Prehistory, CIAS - Research Centre for Anthropology and Health, Department of Life Sciences, University of Coimbra, Coimbra, Portugal; Professora Adjunto, Graduação de Arqueologia, Programa de Pós-graduação em Arqueologia, Centro de Ciências da Natureza, Universidade Federal do Piauí
| | - J d'Oliveira Coelho
- Centre for Functional Ecology (CEF), Department of Life Sciences, University of Coimbra, Coimbra, Portugal
| | - A C Valera
- Era Arqueologia S.A., Portugal; ICArEHB - University of Algarve, Portugal
| | - V Filipe
- UNIARQ, University of Lisbon, Portugal
| | - G R Scott
- Department of Anthropology, University of Nevada Reno, Reno, NV, USA
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Transmasseteric Anterior Parotid Approach for Treatment of Mandibular Subcondylar Fractures. J Craniofac Surg 2018; 29:e690-e693. [PMID: 30157143 DOI: 10.1097/scs.0000000000004922] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
This study demonstrated the application of transmasseteric anterior parotid approach for open reduction of mandibular subcondylar fractures depending on the basis of the anatomical study of the temporomandibular joint and parotid gland area. The anatomical study was performed on 5 Chinese adult cadavers fixed by 10% formalin. The temporomandibular joints and parotid regions were studied. In the clinical study, 26 patients with mandibular subcondylar fractures were recruited between July 2014 and December 2017. All 26 patients with mandibular subcondylar fractures received satisfactory occlusions and normal mouth opening: no postoperative facial paralysis occurred in these patients. It is crucial to know the anatomy of both temporomandibular joint and parotid region for reducing significantly the surgical trauma and complications. Transmasseteric anterior parotid approach is a feasible approach for the surgical treatment of the mandibular subcondylar fractures. This method can provide adequate exposure, minimal facial nerve injury, open reduction easily, and inconspicuous scarring.
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Chandra SR, Zemplenyi KS. Issues in Pediatric Craniofacial Trauma. Facial Plast Surg Clin North Am 2017; 25:581-591. [DOI: 10.1016/j.fsc.2017.06.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Chan YC, Au-Yeung KL. A paediatric case of bilateral mandibular condyle fracture presenting with bloody otorrhoea following trauma. BMJ Case Rep 2017; 2017:bcr-2016-218995. [PMID: 28433980 DOI: 10.1136/bcr-2016-218995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 7-year-old boy presented to the emergency department with bilateral bloody otorrhoea after falling from his scooter. Skull base fracture was suspected. CT showed no evidence of skull base fracture but bilateral mandibular condyle and external acoustic canals fractures. We report this case to illustrate a rare possibility of bilateral external acoustic canal fracture associated with condylar fracture in trauma patients presented with bloody otorrhoea.
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Affiliation(s)
- Yat Chun Chan
- Accident and Emergency, Queen Elizabeth Hospital, Hong Kong
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P RK, G N, P RS, P SC, Krishna Prasad L. An unusual anterior dislocation of fractured mandibular condyle leading to psuedo-ankylosis in a 8 yr old child-A distinct case report. Int J Surg Case Rep 2016; 26:34-7. [PMID: 27448226 PMCID: PMC4957607 DOI: 10.1016/j.ijscr.2016.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 07/09/2016] [Accepted: 07/10/2016] [Indexed: 10/27/2022] Open
Abstract
INTRODUCTION Literature reviews are replete with discussions focusing on the incidence, types, and patterns of disruption in TM joint function, besides enumerating and classifying its causes. However, atypical situations do present, such situations warranting a detailed, methodical assessment before therapeutic institution. PRESENTATION OF CASE Described here is management of a unique case of post-traumatic pseudo-ankylosis in a 8year old child that had an old fractured condyle, displaced and dislocated anteriorly into the sigmoid notch, with eventual fusion to the ipsilateral zygomatic arch on its medial side. DISCUSSION Although conventional imaging tools still have relevance, but the significance of multi detector CT scan with multiplanar reformation and three dimensional images have a become unequivocally a standard part of assessment of such complex facial injuries regardless of therapeutic setting. The probable explanation for the condylar fracture and unusual anterior dislocation of the condylar segment is also hypothesized. CONCLUSION Although Post traumatic ankylosis is common in developing countries like India, distinct cases do present rarely which requires a disciplined approach in the management of such cases.
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Affiliation(s)
- Ranjit Kumar P
- Department of Oral & Maxillofacial Surgery, Sibar Institute of Dental Sciences, Takkellapadu, Guntur, 522509, Andhra Pradesh, India.
| | - Naveen G
- Department of General Surgery, Katuri Medical College, Chinakondrupadu, Guntur, Andhra Pradesh, India, India
| | - Raja Satish P
- Department of Oral & Maxillofacial Surgery, Sibar Institute of Dental Sciences, Takkellapadu, Guntur, 522509, Andhra Pradesh, India
| | - Srinivas Chakravarthy P
- Department of Oral & Maxillofacial Surgery, Sibar Institute of Dental Sciences, Takkellapadu, Guntur, 522509, Andhra Pradesh, India
| | - L Krishna Prasad
- Department of Oral & Maxillofacial Surgery, Sibar Institute of Dental Sciences, Takkellapadu, Guntur, 522509, Andhra Pradesh, India
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Yamashita Y, Inoue M, Aijima R, Danjo A, Goto M. Three-dimensional evaluation of healing joint morphology after closed treatment of condylar fractures. Int J Oral Maxillofac Surg 2016; 45:292-6. [DOI: 10.1016/j.ijom.2015.09.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Revised: 07/27/2015] [Accepted: 09/23/2015] [Indexed: 10/22/2022]
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Theologie-Lygidakis N, Chatzidimitriou K, Tzerbos F, Gouzioti A, Iatrou I. Nonsurgical management of condylar fractures in children: A 15-year clinical retrospective study. J Craniomaxillofac Surg 2016; 44:85-93. [DOI: 10.1016/j.jcms.2015.11.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2015] [Revised: 10/16/2015] [Accepted: 11/23/2015] [Indexed: 11/28/2022] Open
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Sheta M, Shoushan M, Hussein M, Abd Elaal S. Evaluation of using microplates osteosynthesis for pediatric mandibular fractures. TANTA DENTAL JOURNAL 2015; 12:149-155. [DOI: 10.1016/j.tdj.2015.01.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
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Application of the Mandible Injury Severity Score to Pediatric Mandibular Fractures. J Oral Maxillofac Surg 2015; 73:1341-9. [DOI: 10.1016/j.joms.2015.02.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Revised: 01/28/2015] [Accepted: 02/17/2015] [Indexed: 11/23/2022]
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Kim JH, Nam DH. Closed reduction of displaced or dislocated mandibular condyle fractures in children using threaded Kirschner wire and external rubber traction. Int J Oral Maxillofac Surg 2015; 44:1255-9. [PMID: 26117724 DOI: 10.1016/j.ijom.2015.06.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Revised: 04/27/2015] [Accepted: 06/04/2015] [Indexed: 10/23/2022]
Abstract
Most surgeons agree that closed treatment provides the best results for condylar fractures in children. Nevertheless, treatment of the paediatric mandibular condyle fracture that is severely displaced or dislocated is controversial. The purpose of this study was to investigate the long-term clinical and radiological outcomes following the treatment of displaced or dislocated condylar fractures in children using threaded Kirschner wire and external rubber traction. This procedure can strengthen the advantage of closed reduction and make up for the shortcomings of open reduction. From March 1, 2005 to December 25, 2011, 11 children aged between 4 and 12 years with displaced or dislocated mandibular condyle fractures were treated using threaded Kirschner wire and external rubber traction under portable C-arm fluoroscopy. All patients had unilateral displaced or dislocated condylar fractures. The follow-up period ranged from 24 to 42 months (mean 29.3 months). Normal occlusion and pain-free function of the temporomandibular joint, without deviation or limitation of jaw opening, was achieved in all patients. This closed reduction technique in displaced or dislocated condylar fractures in children offers a reliable solution in preventing the unfavourable sequelae of closed treatment and the open technique, such as altered morphology, functional disturbances, and facial nerve damage.
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Affiliation(s)
- J H Kim
- Department of Plastic and Reconstructive Surgery, College of Medicine, Soonchunhyang University Hospital, Cheonan, Chungcheongnam-do, Republic of Korea.
| | - D H Nam
- Department of Plastic and Reconstructive Surgery, College of Medicine, Soonchunhyang University Hospital, Cheonan, Chungcheongnam-do, Republic of Korea
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KSN SB, Kamath RA, S SL, Deepti V, Prabhakar S. Mandibular trauma in Central Karnataka, India – An outcome of 483 cases at a regional maxillofacial surgical unit. JOURNAL OF ORAL AND MAXILLOFACIAL SURGERY, MEDICINE, AND PATHOLOGY 2015. [DOI: 10.1016/j.ajoms.2014.11.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Surgical versus non-surgical treatment of mandibular condylar fractures: a meta-analysis. Int J Oral Maxillofac Surg 2015; 44:158-79. [PMID: 25457827 DOI: 10.1016/j.ijom.2014.09.024] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Revised: 07/14/2014] [Accepted: 09/26/2014] [Indexed: 11/20/2022]
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Lee JS, Jeon EG, Seol GJ, Choi SY, Kim JW, Kwon TG, Paeng JY. Anatomical and Functional Recovery of Intracapsular Fractures of the Mandibular Condyle: Analysis of 124 Cases after Closed Treatment. Maxillofac Plast Reconstr Surg 2014; 36:259-65. [PMID: 27489844 PMCID: PMC4283535 DOI: 10.14402/jkamprs.2014.36.6.259] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2014] [Accepted: 11/06/2014] [Indexed: 12/04/2022] Open
Abstract
Purpose: The purpose of this study is to evaluate the influence of intracapsular fracture lines of the mandibular condyle on the anatomical and functional recovery after non-surgical closed treatment. Methods: Clinical and radiological follow-up of 124 patients with intracapsular fractures of the mandibular condyle was performed after closed treatment between 2005 and 2012. The intracapsular fractures were classified into three categories: type A (medial condylar pole fracture), type B (lateral condylar pole fracture with loss of vertical height) and type M (multiple fragments or comminuted fracture). Results: By radiological finding, fracture types B and M lost up to 24% vertical height of the mandibular condyle compared to the height on the opposite side. In Type M, moderate to severe dysfunction was observed in 33% of the cases. Bilateral fractures were significantly associated with the risk of temporomandibular joint (TMJ) dysfunction in fracture types A and B. Bilateral fracture and TMJ dysfunction were not statistically significantly associated in type M fractures. Conclusion: Most of the mandibular intracapsular condylar fractures recovered acceptably after conservative non-surgical treatment with functional rehabilitation, even with some anatomical shortening of the condylar height. The poor functional recovery encountered in type M fractures, especially in cases with additional fracture sites and bilateral fractures, points up the limitation of closed treatment in such cases.
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Affiliation(s)
- Jong-Sung Lee
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Kyungpook National University
| | - Eun-Gyu Jeon
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Kyungpook National University
| | - Guk-Jin Seol
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Kyungpook National University
| | - So-Young Choi
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Kyungpook National University
| | - Jin-Wook Kim
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Kyungpook National University
| | - Tae-Geon Kwon
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Kyungpook National University
| | - Jun-Young Paeng
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Kyungpook National University
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Conservative treatment of bilateral condylar fractures in children: case report and review of the literature. Int J Pediatr Otorhinolaryngol 2014; 78:1557-62. [PMID: 25048856 DOI: 10.1016/j.ijporl.2014.06.031] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2014] [Revised: 06/25/2014] [Accepted: 06/28/2014] [Indexed: 11/23/2022]
Abstract
Two children (11 year old) with bilateral condylar fractures associated with symphysis fracture were conservatively treated. Both of them were followed up for about 1 year. A review of 21 cases of bilateral condylar fracture available in the literature revealed the younger the patient, the better the outcome of TMJ function or in radiographic remodeling. However, the longer the time elapsed, the higher the incidence of remodeling deformity and dysfunction. Thus, it must be better that a close follow-up of bilateral condylar fracture in children should be continued until the end of growth period.
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Li Z, David O, Li ZB. The use of resorbable plates in association with dental arch stabilization in the treatment of mandibular fractures in children. J Craniomaxillofac Surg 2014; 42:548-51. [DOI: 10.1016/j.jcms.2013.07.025] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Revised: 04/20/2013] [Accepted: 07/17/2013] [Indexed: 10/26/2022] Open
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Repair of a Pediatric Bilateral Condylar and Symphyseal Fracture Using a Transfacial Steinman Pin. J Craniofac Surg 2014; 25:e133-6. [DOI: 10.1097/scs.0000000000000435] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Kaul RP, Sagar S, Singhal M, Kumar A, Jaipuria J, Misra M. Burden of maxillofacial trauma at level 1 trauma center. Craniomaxillofac Trauma Reconstr 2014; 7:126-30. [PMID: 25071877 DOI: 10.1055/s-0034-1371539] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2013] [Accepted: 07/07/2013] [Indexed: 10/25/2022] Open
Abstract
There is an upward trend in facial injuries following changes in population pattern, increasing industrialization and urbanization, hence maxillofacial trauma is becoming a burden and a leading medical problem in emergency rooms worldwide. This study was performed to evaluate the pattern of maxillofacial fractures, associated injuries, and treatment used at Jai Prakash Narayan Apex Trauma Center (JPNATC), All India Institute of Medical Sciences (AIIMS), New Delhi, India, between January 2007 and June 2010. The study provides basis for establishment of trauma as major etiology of maxillofacial injuries and planning for preventive strategies. A retrospective study of patients seen and treated at JPNATC, AIIMS, New Delhi, between January 2007 and June 2010 was performed. Data extracted from patient records included etiology, age, sex, types and sites of fractures, treatment modality, and concomitant injuries. There were 795 fractures of the maxillofacial skeleton and 86 concomitant injuries from 542 patients. Road traffic accident (RTA) (56.8%) was the most common etiologic factor, followed by falls (22.3%) and fights (18.5%). The age range was from 3 to 75 years (mean, 34.7 years) with a peak incidence in the third decade with a male-to-female ratio of 3.7:1. The most common location of maxillofacial fractures was the mandible 615 (77%) and middle third 180 (23%). With regard to mandibular fractures, the body (29.6%) was the most common site, followed by the angle (24.4%), ramus (19.5%), dentoalveolar (14.6%), symphysis (11.0%), condyle (0.8%) while in the middle third, the nasal bone (36.7%) was the most common, followed by zygomatic bone (27.8), Lefort II (14.4), Lefort I (7.8%), dentoalveolar (10.0%), and Lefort III (3.3%). Majority of the patients were treated by open reduction and internal fixation (70.6). Concomitant injuries were 84 (10.8%) with orthopedic injuries accounting for the majority (63.9%). Head injury was associated in 16.3% of cases. RTA was the major etiologic factor of maxillofacial injuries in our setting and the young adult males were the main victims. Henceforth, establishment of regionalized, efficient, and focused trauma centers in various parts of the country particularly for acute trauma should be emphasized. Also, the laws regarding the precautions such as seat belts, speed limits, and traffic rules must be observed strictly to reduce the incidence of RTA.
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Affiliation(s)
- Ruchi Pathak Kaul
- Department of Surgery, Jai Prakash Narayan Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, India
| | - Sushma Sagar
- Department of Surgery, Jai Prakash Narayan Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, India
| | - Maneesh Singhal
- Department of Surgery, Jai Prakash Narayan Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, India
| | - Abhishek Kumar
- Department of Surgery, Jai Prakash Narayan Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, India
| | - Jiten Jaipuria
- Department of Surgery, Jai Prakash Narayan Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, India
| | - Mahesh Misra
- Department of Surgery, Jai Prakash Narayan Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, India
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Kim TW, Seo EW, Song SI. Open reduction and internal fixation of mandibular fracture in an 11-month-old infant: a case report. J Korean Assoc Oral Maxillofac Surg 2014; 39:90-3. [PMID: 24471024 PMCID: PMC3858152 DOI: 10.5125/jkaoms.2013.39.2.90] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2013] [Revised: 03/29/2013] [Accepted: 03/30/2013] [Indexed: 11/14/2022] Open
Abstract
Mandibular fractures in infants are rare. This case report describes management of a mandibular fracture in an 11-month-old infant using a microplate and screws with open reduction. The surgical treatment was successful. Because the bone fragments were displaced and only the primary incisors had erupted, conservative treatment, such as an acrylic splint and circummandibular wiring, was not recommended. Nine weeks after surgery, the microplate was removed. The results showed complete clinical and radiological bone healing with normal eruption of deciduous teeth.
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Affiliation(s)
- Tae-Wan Kim
- Department of Dentistry, Bundang Jesaeng Hospital, Daejin Medical Center, Seongnam, Korea
| | - Eun-Woo Seo
- Department of Dentistry, Oral and Maxillofacial Surgery, Ajou University School of Medicine, Suwon, Korea
| | - Seung-Il Song
- Department of Dentistry, Oral and Maxillofacial Surgery, Ajou University School of Medicine, Suwon, Korea
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Liu CK, Meng FW, Tan XY, Xu J, Liu HW, Liu SX, Huang HT, Yan RZ, Hu M, Hu KJ. Clinical and radiological outcomes after treatment of sagittal fracture of mandibular condyle (SFMC) by using occlusal splint in children. Br J Oral Maxillofac Surg 2013; 52:144-8. [PMID: 24262674 DOI: 10.1016/j.bjoms.2013.10.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Accepted: 10/23/2013] [Indexed: 11/17/2022]
Abstract
This study was designed to investigate the effects of occlusal splints in the treatment of sagittal fractures of the mandibular condyle in children. From January 1995 to December 2011, 37 sagittal fractures of the mandibular condyle in 30 patients aged 4-8 years old were included in this study. All the patients were treated with 1-2mm occlusal splints in the molar region. The mouths of the patients were kept slightly open by the occlusal splints for 3-6 months, and we reviewed the clinical and radiological remodelling of the affected condyles after treatment. Excellent (n=20) and good (n=10) clinical outcomes were achieved with full radiological remodelling seen in 19 and partial remodelling in 11. Treatment with occlusal splints is effective in delivering good results and function with minimal morbidity in children with sagittal fractures of the condyle, while permitting ongoing remodelling and growth in the short term.
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Affiliation(s)
- Chang-Kui Liu
- Department of Stomatology, General Hospital of the PLA, Beijing 100853, China
| | - Fan-Wen Meng
- Department of Stomatology, 359th Hospital of the People's Libration Army, Zhenjiang 212001, China
| | - Xin-Ying Tan
- Department of Stomatology, General Hospital of the PLA, Beijing 100853, China
| | - Juan Xu
- Department of Stomatology, General Hospital of the PLA, Beijing 100853, China
| | - Hua-Wei Liu
- Department of Stomatology, General Hospital of the PLA, Beijing 100853, China
| | - San-Xia Liu
- Department of Stomatology, General Hospital of the PLA, Beijing 100853, China
| | - Hai-Tao Huang
- Department of Stomatology, General Hospital of the PLA, Beijing 100853, China
| | - Rong-Zeng Yan
- Department of Stomatology, General Hospital of the PLA, Beijing 100853, China
| | - Min Hu
- Department of Stomatology, General Hospital of the PLA, Beijing 100853, China.
| | - Kai-Jin Hu
- Department of Oral and Maxillofacial Surgery, School of Stomatology, The Fourth Military Medical University, Xi'an 710032, China.
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40
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Kisnisci R. Management of Fractures of the Condyle, Condylar Neck, and Coronoid Process. Oral Maxillofac Surg Clin North Am 2013; 25:573-90. [DOI: 10.1016/j.coms.2013.07.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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41
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Wolfswinkel EM, Weathers WM, Wirthlin JO, Monson LA, Hollier LH, Khechoyan DY. Management of Pediatric Mandible Fractures. Otolaryngol Clin North Am 2013; 46:791-806. [DOI: 10.1016/j.otc.2013.06.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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42
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Qing-Bin Z, Zhao-Qiang Z, Dan C, Yan Z. Epidemiology of maxillofacial injury in children under 15 years of age in southern China. Oral Surg Oral Med Oral Pathol Oral Radiol 2013; 115:436-41. [DOI: 10.1016/j.oooo.2012.04.026] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2011] [Revised: 03/24/2012] [Accepted: 04/03/2012] [Indexed: 10/27/2022]
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43
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Vesnaver A, Ahčan U, Rozman J. Evaluation of surgical treatment in mandibular condyle fractures. J Craniomaxillofac Surg 2012; 40:647-53. [DOI: 10.1016/j.jcms.2011.10.029] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2011] [Revised: 09/26/2011] [Accepted: 10/06/2011] [Indexed: 11/26/2022] Open
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44
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Bruckmoser E, Undt G. Management and outcome of condylar fractures in children and adolescents: A review of the literature. Oral Surg Oral Med Oral Pathol Oral Radiol 2012; 114:S86-S106. [DOI: 10.1016/j.oooo.2011.08.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2011] [Revised: 07/25/2011] [Accepted: 08/23/2011] [Indexed: 10/28/2022]
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Nardis ADC, Costa SAP, da Silva RA, Kaba SCP. Patterns of paediatric facial fractures in a hospital of São Paulo, Brazil: a retrospective study of 3 years. J Craniomaxillofac Surg 2012; 41:226-9. [PMID: 23062741 DOI: 10.1016/j.jcms.2012.09.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2012] [Revised: 09/04/2012] [Accepted: 09/04/2012] [Indexed: 11/25/2022] Open
Abstract
The objective of this study is to analyze patterns of facial fractures in children treated at the Service of Oral and Maxillofacial Surgery of the Vila Penteado General Hospital (HGVP), in São Paulo, Brazil, in a period of 3 years. Between May 2008 and April 2011 the authors reviewed 110 records of patients under 12 years old with facial fractures. The following parameters were evaluated: age and sex distribution, aetiology of trauma, incidence and type of fractures, monthly distribution and treatment modality. Male-to-female ratio was 1.8:1, and the mean age was 8.13. The majority of the involved patients were aged between 6 and 12 years. The most prevalent cause was fall (58%) and nasal fractures were the most common type of fracture (69%). Monthly distribution was similar in all seasons. Of 110 patients, 69 (62%) were treated conservatively. The incidence of facial fractures in the area of study is high. The high incidence of nasal fractures should be a warning to maxillofacial surgeons, so that they are not overlooked. Safety programs should be installed in Brazil to increase public awareness and to decrease morbidity resulting from paediatric trauma.
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Affiliation(s)
- Amanda da Costa Nardis
- Department of Oral and Maxillofacial Surgery, Vila Penteado General Hospital, Av. Ministro Petrônio Portela, 1642, Freguesia do Ó, CEP: 02802-120, São Paulo, SP, Brazil.
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46
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Chrcanovic BR. Open versus closed reduction: mandibular condylar fractures in children. Oral Maxillofac Surg 2012; 16:245-255. [PMID: 22842853 DOI: 10.1007/s10006-012-0344-7] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2012] [Accepted: 07/16/2012] [Indexed: 06/01/2023]
Abstract
PURPOSE The purpose of the study was to review the literature regarding the evolution of current thoughts on management of mandibular condylar fractures (MCFs) in children. METHODS An electronic search in PubMed was undertaken in May 2012. The titles and abstracts from these results were read to identify studies within the selection criteria. Eligibility criteria included studies published in English or German from the last 20 years (from 1992 onwards) reporting clinical series of MCFs in children and adolescents until the age of 18. RESULTS The search strategy initially identified 542 studies. The references from 1992 onwards totaled 339 articles. Twenty-seven studies were identified without repetition within the selection criteria. Additional hand-searching yielded two additional papers. CONCLUSIONS Pediatric MCFs require thoughtful consideration in management to avoid significant growth disturbance. Early treatment is indicated in order to improve the chances for favorable development. Long-term follow-up is required, in order to properly treat late complications that may appear. Coronal computed tomography is helpful in substantiating the correct final diagnosis. Many studies show that conservative treatment (CTR) has satisfactory long-term outcome of jaw function, occlusion, and facial esthetics, despite a high frequency of radiological aberrations. Surgery before puberty should be reserved for exceptional cases such as missile injuries, in cases with extensive dislocation and lack of contact between the fragments, in cases with multiple midfacial fractures, in which the mandible has to serve as a guide to reposition the midfacial bones, and in cases which the dislocation of the fractured stump creates a functional impediment that cannot be resolved by CTR. As the craniofacial skeleton becomes more adult-like in its form at about 12 years of age, the decreased remodeling capacity in the adolescents may occasionally result in abnormally shaped condylar heads or shortened ramus heights that may lead to persistent malocclusion. Thus, the indication of open reduction and internal fixation increases with age.
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Management of mandibular fractures in children with a split acrylic splint: a case series. Br J Oral Maxillofac Surg 2012; 50:e93-5. [DOI: 10.1016/j.bjoms.2011.11.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2011] [Accepted: 11/03/2011] [Indexed: 11/21/2022]
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48
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Zhao YM, Yang J, Bai RC, Ge LH, Zhang Y. A retrospective study of using removable occlusal splint in the treatment of condylar fracture in children. J Craniomaxillofac Surg 2012; 42:1078-82. [PMID: 22939640 DOI: 10.1016/j.jcms.2012.07.010] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2011] [Revised: 07/04/2012] [Accepted: 07/05/2012] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Although the concept of conservative treatment for paediatric condylar fracture is well understood, there is still a lack of a recognized method for treating child patients with a condylar fracture. The purpose of this study was to investigate the effect of the removable occlusal splint in treating condylar fractures in children and adolescents. MATERIALS AND METHODS Forty children and adolescents with condylar fracture, aged 3-16, were included in this study. A removable occlusal splint with varying thickness was fabricated according to the age, developmental stage of the mandible, and degree of condylar dislocation. This was worn for 1-3 months, accompanied by functional exercises. Follow-up was carried out by clinical observation and panoramic X-ray. RESULTS Clinically satisfactory results with good occlusion were obtained in all the patients, along with unimpaired function and normal growth and development of the mandible. The panoramic image showed remodelling and reconstruction of the fractured condyles. CONCLUSIONS Our results confirm that conservative treatment has a satisfactory clinical outcome in treating condylar fracture in children. The removable occlusal splint is a promising approach for treating condylar fracture in children and adolescents.
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Affiliation(s)
- Yu-ming Zhao
- Department of Paediatric Dentistry (Head: Prof. Man Qin), Peking University School and Hospital of Stomatology, Beijing, China
| | - Jie Yang
- Department of Paediatric Dentistry (Head: Prof. Man Qin), Peking University School and Hospital of Stomatology, Beijing, China
| | - Rui-chun Bai
- Department of Paediatric Dentistry (Head: Prof. Man Qin), Peking University School and Hospital of Stomatology, Beijing, China
| | - Li-hong Ge
- Department of Paediatric Dentistry (Head: Prof. Man Qin), Peking University School and Hospital of Stomatology, Beijing, China
| | - Yi Zhang
- Department of Oral and Maxillofacial Surgery (Head: Prof. Yi Zhang), Peking University School and Hospital of Stomatology, Beijing, China.
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Current Concepts in the Mandibular Condyle Fracture Management Part II: Open Reduction Versus Closed Reduction. Arch Plast Surg 2012; 39:301-8. [PMID: 22872831 PMCID: PMC3408273 DOI: 10.5999/aps.2012.39.4.301] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2012] [Revised: 07/09/2012] [Accepted: 07/10/2012] [Indexed: 11/24/2022] Open
Abstract
In the treatment of mandibular condyle fracture, conservative treatment using closed reduction or surgical treatment using open reduction can be used. Management of mandibular condylar fractures remains a source of ongoing controversy in oral and maxillofacial trauma. For each type of condylar fracture,the treatment method must be chosen taking into consideration the presence of teeth, fracture height, patient'sadaptation, patient's masticatory system, disturbance of occlusal function, and deviation of the mandible. In the past, closed reduction with concomitant active physical therapy conducted after intermaxillary fixation during the recovery period had been mainly used, but in recent years, open treatment of condylar fractures with rigid internal fixation has become more common. The objective of this review was to evaluate the main variables that determine the choice of an open or closed method for treatment of condylar fractures, identifying their indications, advantages, and disadvantages, and to appraise the current evidence regarding the effectiveness of interventions that are used in the management of fractures of the mandibular condyle.
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Abstract
Despite recent advances in the diagnosis, treatment, and prevention of pediatric facial fractures, little has been published on the complications of these fractures. The existing literature is highly variable regarding both the definition and the reporting of adverse events. Although the incidence of pediatric facial fractures is relative low, they are strongly associated with other serious injuries. Both the fractures and their treatment may have long-term consequence on growth and development of the immature face. This article is a selective review of the literature on facial fracture complications with special emphasis on the complications unique to pediatric patients. We also present our classification system to evaluate adverse outcomes associated with pediatric facial fractures. Prospective, long-term studies are needed to fully understand and appreciate the complexity of treating children with facial fractures and determining the true incidence, subsequent growth, and nature of their complications.
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